Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus
- PMID: 25339643
- DOI: 10.1093/rheumatology/keu384
Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus
Abstract
Objective: The aim of this study was to develop and validate an algorithm to assist the attribution of neuropsychiatric (NP) events to underlying disease in SLE patients.
Methods: Phase 1 identified and categorized candidate items to be included in the algorithm for the attribution of an NP event to SLE and their relative weights through a literature-informed consensus-driven process. Using a retrospective training cohort of SLE, phase 2 validated items selected in phase 1 and refined weights through a data-driven process, fitting items as independent variables and expert evaluation (clinical judgement) as reference standard in logistic models. Phase 3 consisted of a validation process using an external multicentre retrospective SLE cohort.
Results: Phase 1 identified four different items: timing of the NP event, type of event, confounding factors and favouring factors. The training and validating cohorts included 228 and 221 patients, respectively. Each patient experienced at least one NP event characterized using the ACR case definition. In these samples, items selected in phase 1 showed good performance in discriminating patients with NPSLE: the area under the receiver operating characteristic curve using dichotomous outcomes was 0.87 in the training set and 0.82 in the validating set. Relevant cut-offs of the validated score identify events with a positive predictive value of 100% (95% CI 93.2, 100) and 86.3% (95% CI 76.2, 93.2) in the training and validating cohorts, respectively.
Conclusion: A new algorithm based on a probability score was developed and validated to determine the relationship between NP events and SLE.
Keywords: attribution model; neuropsychiatric; systemic lupus erythematosus.
© The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Comment in
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Attribution in the assessment of nervous system disease in SLE.Rheumatology (Oxford). 2015 May;54(5):755-6. doi: 10.1093/rheumatology/keu458. Epub 2014 Dec 5. Rheumatology (Oxford). 2015. PMID: 25480812 Free PMC article. No abstract available.
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